Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

Abstract

For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.

Keywords: DEBIRI TACE; Yttrium-90; interventional oncology in metastatic colorectal cancer; liver intraarterial hepatic therapies; metastatic colorectal cancer; tumor ablation.

Figure 1

Algorithm treatment of LMCRC. Adapted from [5,19]. Abbreviations: IRE—irreversible electroporation, MWA—microwave ablation, SBRT—stereotactic body radiotherapy, TACE—transarterial chemoembolization, RE—radioembolization, RFA—radiofrequency ablation. * Y90 radiation segmentectomy is indicated for tumors near major bile ducts or vascular structures.